Available online at www.ijmrhs.com
ISSN No: 2319-5886
International Journal of Medical Research &
Health Sciences, 2016, 5, 5:196-199
A seroprevalence evaluation study of Hepatitis B virus, Hepatitis C virus and
Herpes Simplex Virus - 2 among a special study group
*Mangala Adisesh1, Thilakavathy Natesan2, Sathishkumar Elumalai3, Kalaivani
Subramanian4
1
2
Institute of Microbiology, Madras Medical College & RGGGH, Chennai, India
Department of Microbiology, Government Stanley Medical College & Hospital, Chennai, India
3
Department of Serology, Institute of Venereology, Madras Medical College & RGGGH,
Chennai, India
4
Institute of Venereology, Madras Medical College & RGGGH, Chennai, India
Corresponding E-mail: [email protected]
_____________________________________________________________________________________________
ABSTRACT
Viral STI are silent diseases. Most of them are symptomless, but have the potential to be transmitted to fetus and
other sexual partners. Female sex workers, men who have sex with men are at high risk of getting STIs and
individuals with certain STIs are at three to five-fold risk of getting HIV infection. Hence, the present study was
carried out to know the seroprevalence of HBV, HCV and HSV-2 among our study group. A multi-centric cross
sectional study was conducted. A total of 4062 serum samples were tested during the period January to December
2010. Serum samples were tested for HBsAg, anti-HCV and HSV-2 IgM using commercially available ELISA kits.
Overall prevalence of HBV, HCV and HSV-2 were 2.8% (114/4062), 2% (84/4062) and 2.4% (96/4062)
respectively. Most of the HBsAg positive cases were in the age-group of 20 to 25 years. We have observed that the
positivity of all STIs studied was higher in transgender. Individuals infected with STIs are at the risk of contracting
HIV, and co-infection with hepatitis can complicate the treatment for HIV. Screening of asymptomatic individuals
will be helpful; prompt treatment of these STI will prevent ongoing transmissions as sex works are the critical core
group.
Keywords: Hepatitis, Herpes simplex, STI, ELISA
_____________________________________________________________________________________________
INTRODUCTION
Viral STI are silent diseases. Most of them are symptomless, but have the potential to be transmitted to fetus and
other sexual partners. Sexually transmitted viral infections and viral hepatitis are major health problem in
developing countries. Prolonged infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are a leading
cause of hepatocellular carcinoma [1]. WHO estimated that more than 1 million people acquire a sexually transmitted
infection (STI) every day and more than 530 million people have the herpes simples virus – 2 (HSV-2) infection[2].
Infections due to hepatitis B and herpes are incurable, but we can reduce the severity through treatment. Female sex
workers (FSW), men who have sex with men (MSM) are at high risk of getting STIs and individuals with certain
STIs are at three to five-fold risk of getting HIV infection[3].
Study reports from United States indicated that about 33% of all HIV-infected persons are HCV infected, and 5-15%
of HIV-infected persons are co-infected with HBV [4,5]. Genital herpes, which is one of the most prevalent STIs
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Int J Med Res Health Sci. 2016, 5(5):196-199
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globally including India, has been rising significantly over the past few years [6]. Hence, the present study was
carried out to know the seroprevalence of HBV, HCV and HSV-2 among FSW, MSM and transgender (TG).
MATERIALS AND METHODS
A multi-centric cross sectional study was conducted to know the prevalence of sexually transmitted diseases among
FSW, MSM and TG across Tamil Nadu. Institutional ethical clearance was obtained to conduct this study.
Participation of individuals was voluntary and free of cost. All participants were informed about the test outcome
and medical advice and counseling were given accordingly.
After getting informed consent from the patients, 5ml blood sample was aseptically drawn in a vacutainer, serum
separated, correctly labeled and stored in a refrigerator. These samples were sent to Department of Serology,
Institute of Venerelogy, RGGGH and MMC, Chennai on a weekly basis, cold chain was maintained until testing.
A total of 4062 serum samples were tested at the above lab during the period January to December 2010. Serum
samples were tested for HBsAg by a commercially available ELISA kit (ErbaLisa, Germany). Antibodies to HCV
were tested by SP-NANBASE C-96, 3.0 (General Biologicals Corporation, Taiwan). Serological diagnosis for IgM
antibody to HSV-2 was done using HSV-2 IgM ELISA kit (Calbiotech, Inc. CA, USA). All the tests were carried
out according to the manufacturers’ instruction. Individuals who were HBsAg negative were guided for vaccination.
RESULTS
A total of 4062 patients were included in this study of which the majority were females (62.3%, 2532/4062)
followed by males (34.4%, 1398/4062) and transgender (TG) (3.2%, 132/4062). Overall prevalence of HBV, HCV
and HSV-2 were 2.8% (114/4062), 2% (84/4062) and 2.4% (96/4062) respectively (Table 1). Most of the HBsAg
positive cases were in the age-group of 20 to 25 years. The positivity of STIs with respect to the age-group was
given in table 2. We have observed that the positivity of all STIs studied (i.e. 4.5% positive for HBV and 3%
positive for both HCV and HSV-2) was higher in transgender. The prevalence of HBsAg was high (3.6%) in males
than females (2.3%), where as anti-HCV and HSV-2 IgM positivity was higher in female participants than male
participants (Table 1).
Table: 1. Gender-wise distribution of HBV, HCV and HSV-2 infection.
Gender
Total No. of Cases
Male
Female
TG
Total
1398
2532
132
4062
Number of positives (%)
HBV
HCV
HSV-2
50 (3.6)
27 (1.9) 20 (1.4)
58 (2.3)
53 (2.1) 72 (2.8)
6 (4.5)
4 (3)
4 (3)
114 (2.8)
84 (2)
96 (2.4)
Table: 2. Age-wise prevalence of HBV, HCV and HSV-2 infection.
Age group (years)
Upto 19
20 to 25
26 to 30
31 to 35
36 to 40
41 to 45
46 to 50
Above 50
Total
HBV Positive
M
F
TG
1
0
0
23
8
0
10
9
1
5
13
2
6
16
2
2
10
1
1
2
0
2
0
0
50 58
6
HCV Positive
M
F
TG
1
0
0
9
4
1
14
5
1
2
12
0
0
17
1
0
10
0
1
5
1
0
0
0
27 53
4
HSV-2 Positive
M
F
TG
2
1
0
6
13
2
5
13
0
1
21
0
1
17
2
4
2
0
0
4
0
1
1
0
20 72
4
DISCUSSION
Sexually Transmitted Diseases are among the most common infectious diseases around the world. In our study,
HBV (2.8%) was the commonest infection followed by HSV-2 (2.4%) and HCV (2%). Commercial sex workers and
individuals with high risk sexual behaviours are at greater chance of acquiring STIs [7].
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Studies on the prevalence of viral STIs among FSW, MSM and transgender are limited. HBV prevalence in different
study population has been reported to vary widely from 0.1% in the developed countries to 20% in the developing
nations [8]. Recent study from North India revealed that the prevalence of HBV and HCV among FSW was 8% and
2.4% respectively, which is comparatively higher than our study result [9]. Study report on Hepatitis B and C
prevalence in high risk groups in north Kerala, India reported 3.47% HBsAg positivity and 2.6 % anti-HCV
positivity in commercial sex workers; 4.49% HBsAg positive and 3.37% anti-HCV positive in male homosexuals
[10]
. Recent study on the prevalence and risks of hepatitis and STIs in China during the period of 2000–2011 revealed
the seroprevalence of hepatitis B and hepatitis C among FSW were 10.7 % and 1.0 %, respectively [11].
According to the recent report, there were 417 million people living with HSV-2 infection world-wide with the
global prevalence of 11.3% [12]. Very few reports on HSV-2 prevalence were available in India and varies between
1.0% and 18.9% among general population [13-19]. The HSV-2 prevalence among sexually transmitted disease clinic
attendees has been reported to range between 9.7% and 83% and between 2.0% and 79.0% among high risk groups
[20]
. The prevalence of HSV-2 in our study was 2.4%.
CONCLUSION
Individuals infected with STIs are at the risk of contracting HIV, and co-infection with hepatitis can complicate the
treatment for HIV [11]. It has been documented that STI treatment interventions can help significantly in the
prevention of HIV infection [21]. The epidemiological profile of STIs varies considerably based on ethnographic,
demographic, socioeconomic and health factors [22]. Screening of asymptomatic individuals will be helpful; prompt
treatment of these STI will prevent ongoing transmissions as sex works are the critical core group. We can control
these infectious diseases by developing strategies to reduce high risk behavior, sex education and awareness
regarding sexually transmitted infections among the vulnerable population.
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